How does vaginal health influence UTI risk?

Maintaining vaginal health can be a pivotal role in urinary health, and we know you had a lot of questions on this topic!

We interviewed Dr. Carrie Aisen, a San Diego-based Urologist, so she can give you a closer look into how vaginal health can impact urinary health.

What is the vaginal microbiome?

The vaginal microbiome is the microorganisms that live in the vagina. The main microorganism for a healthy vaginal microbiome is lactobacilli. Lactobacilli prevent harmful pathogens through several mechanisms such as producing lactic acid to keep the vagina at its normal acidic pH and producing antimicrobials like hydrogen peroxide.

Why is it important to maintain vaginal pH at a healthy range when it comes to our urinary health?

A healthy vaginal pH is an acidic pH and the vaginal microbiome needs this to thrive. A healthy vaginal microbiome also helps keep the vagina at an acidic pH. These microorganisms can help protect the vagina and body against harmful microorganisms that cause infections, like UTIs.

There are a lot of factors that can impact vaginal health and the vaginal microbiome. Anything that alters the vaginal microbiome causes an increased risk of urinary tract infections.

Factors that can impact the vaginal microbiome could include;

• Taking antibiotics
• Menopause also causes a change in the vaginal microbiome
• Some birth control pills can also cause vaginal pH to change however there is no evidence suggesting that Oral Contraceptive Pills (OCP) use increases the risk of UTIs.

Why should we be aware of the products we’re using in, or near our vaginas?

Any products that are used in the vagina or on the vulva can impact the vaginal microbiome and can cause loss of healthy bacteria, therefore potentially increase the risk of infections such as UTIs.  

However, there is great interest in the role of vaginal probiotics in the prevention of UTIs. While we do not have conclusive evidence, there is one small study on patients with recurrent UTIs that did show an intravaginal suppository of Lactobacillus crispatus did lead to a slight decrease in UTI risk.

Hopefully, there will be more research on ways to promote and restore the vaginal microbiome for patients struggling with UTIs. In the meantime, many doctors who treat UTIs recommend vaginal probiotics and eating yogurt.

What is vaginal dryness, and how can this occur?

The vagina has natural lubrication that can be lost with a change in hormone levels. The cells lining the vagina become thinner and the secretions decrease causing pain and dryness. This change in hormone levels is seen during menopause and the vaginal and urinary symptoms are called genitourinary syndrome of menopause (GSM).

Symptoms of GSM include;

• Vaginal itching
• Burning
• Dryness
• Pain with intercourse
• Urinary urgency and frequency.

Hormonal changes are not limited to menopause. They can also be seen during breastfeeding or when taking hormonal birth control. Other medications including antiestrogen medications, certain antidepressants, and antihistamines can cause vaginal dryness as well.

According to the Cleveland Clinic, around 17% of people assigned female gender at birth between the ages of 18 and 50 years old report that they experience vaginal dryness and this increases to over 50% after menopause.

How can vaginal dryness contribute to UTIs?

The same condition of hormonal changes that cause vaginal dryness also causes the change in vaginal microbiome and pH level. This could cause an increased risk of UTIs. Talk with your doctor about if you are going through genitourinary syndrome of menopause to explore what treatment options are available to you, such as vaginal estrogen.

What does vaginal dryness feel like?

It often presents as vaginal pain, itching, burning, and pain with intercourse. Genitourinary syndrome of menopause can present very similarly to urinary tract infections. Typically UTIs are characterized by sudden onset in burning with urination, urgency, and frequency, and you may see blood in the urine. If symptoms come and go or last for long periods of time this is more consistent with lower urinary tract symptoms and are also seen during genitourinary syndrome of menopause.  

Genitourinary syndrome of menopause can present very similarly to urinary tract infections.

- Dr. Carrie Aisen

Can personal lubricants help with vaginal dryness during sex?

Personal lubes are very important to help with vaginal dryness. Some products aim to treat dryness like vaginal estrogen or hyaluronic acid suppositories. Others focus on increasing lubrication during sex and this includes water-based, silicone-based, and oil-based.

What type of lubes do you recommend? Or what ingredients should be avoided?

As discussed above, anything that goes in or near the vagina can impact vaginal health, the microbiome, and the risk of developing an infection such as UTIs.

• Water-based lubricants without flavors or scents tend to be the safest in terms of minimal altering of the vaginal microbiome, and not increasing the risk of UTIs.
• Silicone-based lubricants can be nice because they last longer but should not be used with silicone sex toys because they can damage them.
• Oil-based lubricants such as coconut oil can provide a natural option but they can degrade latex condoms and there is concern it may disrupt the vaginal flora due to naturally antimicrobial properties.

When searching for a lube that works for your needs, it is important to find lubricants that match the vaginal pH and do not have any fragrances. Other ingredients to avoid are glycerin and sorbitol as these are sugars and may increase your risk of yeast infections and chlorhexidine which is an antibacterial agent.

Here’s what we learned from Dr. Aisen

Vaginal health can be influenced by a multitude of factors including menopause, taking antibiotics or other medications, using certain types of lubes, and more. The good news? Knowledge is power when it comes to our health. Knowing what can impact the balance of the vaginal microbiome can be empowering in our urinary health journey so we have the knowledge to take charge of our health!

About the author

Dr. Carrie Aisen is a San Diego-based urologist focused on evidence-based medicine. Dr. Aisen received her MD from Columbia University.

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